Enrollment Specialist I/II/III/IV (Government Programs: CHP/QHP- Multiple Positions Available)

Enrollment Specialist

Under the direction of the Assigned Management, upon successful completion of all phases of training, and in accordance with established HIPAA regulations the Enrollment Specialist performs enrollment core processing and servicing in accordance with the Health Plan Operation's enrollment regulations, Underwriting Guidelines and applicable government regulations. The focus of this role is to ensure prompt, accurate, and efficient servicing of all broker, member and group administrator inquiries for all product lines. Inquiries are received by the following but not limited to; telephone, email, written inquiries, lobby walk-in customers and through on-site visits with an employer group. The B version of this role will require the individual to be on the phone regularly.

Essential Primary Responsibilities/Accountabilities:

Level I:

• Responsible for Government Programs, Small, Mid, and Large Employer Group Subscriber Enrollment Operations.
• Responsible for maintaining communication, including but not limited to; Enrollment Management, Account Services Consultants, Sales, Finance/Underwriting, Claims, Customer Care, as well as interact with external Customers, groups or Brokers as necessary.
• Responsible for the enrollment of new groups, renewals, new member and member movement.
• Prepares, processes and maintains all member enrollments utilizing multiple Health Plan enrollment systems. Installs and maintains member information, new enrollment, benefit changes/renewal, cancellations, and reinstatements utilizing multiple sales, marketplace, and/or Enrollment systems. Review and assess member enrollment activity and associated documents for accuracy using knowledge and expertise of processing regulations/guidelines.
• Researches, interprets and responds to inquiries from internal and external customers, business partners, brokers, consultants, and groups concerning our products, services and policies in accordance with regulatory, corporate policy, association guidelines and productivity measures. Ability to run pre-built reports.
• Reviews, validates and updates transaction errors from all member level electronic and paper sources impacting eligibility interfaces.
• Identifies issues and responds to all work items brought forward either internally or externally and ensures all inquiries will be responded to within department service level agreements (SLA's).
• Prioritize aged and Performance Guarantee Transactions and takes necessary action to complete timely according to established metrics.
• Responsible for knowledge and accuracy on entry level processing within a minimum of 3 inventory areas.
• Attends provided/necessary training to support job role/function and share knowledge back with the team.
• Attends and participates in meetings as necessary and share information back to the team.
• Execution of quality service to our external, as well as internal customers by meeting productivity and accuracy metrics, compliance and member touchpoint measures (MTM) targets, and CMS processing timeframes.
• General understanding of the cross functional enrollment process and operating systems.
• Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values, adhering to the Corporate Code of Conduct, and Leading to the Lifetime Way values and beliefs.
• Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
• Regular and reliable attendance is expected and required.
• Performs other functions as assigned by management.

Level II - in addition to Level I responsibilities, will perform the following:

• Prepares, processes and maintains all group enrollment utilizing multiple Health Plan enrollment systems. Installs and maintains group information including new group set up, benefit changes/renewal, cancellations, and reinstatements utilizing multiple sales, marketplace, and/or Enrollment systems. Review and assess enrollment activity and associated documents for accuracy using knowledge and expertise of processing regulations/guidelines.
• Handles Designated Record Set (DRS) requests and may serve as a point person for the Account Service team when difficulties arise in obtaining information through normal channels.
• Adjusts or triages for adjustment, as situation requires, enrollment for subscriber additions, deletions and changes, and will initiate correspondence requesting additional information or verification.
• Acts as a resource to support and or cross train other team members.
• Responsible for knowledge and accuracy on at least half of inventory areas.
• In depth understanding and working knowledge of the cross functional enrollment process and operating systems.
• Identifies issues, patterns and/or trends generated by external and internal action affecting compliance, customer satisfaction and system performance. Consistently and independently recommends and initiates changes and improvement as a result of process review.
• Assists in creating and/or updating the operating manuals and/or Desk Level Procedures (DLP's).
• Staff the Enrollment phone lines to resolve inbound telephone inquiries promptly and accurately.

Level III - in addition to Level II responsibilities, will perform the following:

• Proficient in most inventory areas, operating systems with expertise in specific job functions.
• Mentors and collaborates with others on the team in utilizing tools, sharing best practices, and serving as a role model within a team unit structure.
• Serves as subject matter expert for the department. Ability to cross train on any task as demonstrated by comprehension and retention of new skills not limited to a primary line of business. Works continuously toward identifying and removing barriers to increased productivity, quality, cost effectiveness, timeliness of operations, and customer satisfaction.
• Process enrollment activities for complex accounts.
• Ability to adjust daily assignments to prioritize urgent or complex cases as they arise.
• Researches, responds, and resolves eligibility inquires working directly with internal and external customers via multiple communication methods.
• May assist with system releases and production validation.

Level IV - in addition to Level III responsibilities, will perform the following:

• Creation of test cases, testing of the process, documents and establishes procedures for the implementation of new products and work efforts. May be asked to participate in end user testing.
• Researches complex cases to identify root cause, recommend and execute resolution through completion.
• Responsible for complex and/or sensitive cases including but not limited to processing for key brokers, accounts, special arrangements, government programs and/or enrollment resolution cases requiring deep research.
• Serves as department representative on corporate projects as well as cross functional work groups as assigned acting as a subject matter expert. Provides advice and counsel to project teams and leadership on implications of requirements on productivity and quality.

Minimum Qualifications:

NOTE: We include multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In addition to using this differentiated approach to place new hires, it also provides guideposts for employee development and promotional opportunities.

Level I:

• Completed High School Diploma or Equivalent.
• Minimum of two (2) years health insurance or related operations work experience and proven ability to exercise the requirements and responsibilities of the position, preferred.
• Must have solid written and verbal communication skills.
• Proven organizational, analytical, and time management skills.
• Basic Computer proficiency, including experience in Microsoft Office Suite.
• Attention to detail and accuracy.
• Ability to multi-task in order to efficiently resolve customer concerns, by understanding the needs of the customer, navigating screens on the computer, typing inquiry documentation.
• B Version: Ability to actively listen to customer while simultaneously taking notes. Ability to be on the phone regularly.

Level II:

• Minimum of three (3) years health insurance or related operations work experience and proven ability to exercise the requirements and responsibilities of the position preferred.
• Rating of "Performing" or above for minimally 12 months.
• Organizational, reasoning and problem-solving skills.
• Takes accountability and ownership of issues and resolution with minimal supervision.
• Demonstrates global thinking and takes initiative to recognize opportunities within the team.
• B Version: Ability to actively listen to customer while simultaneously taking notes. Ability to be on the phone regularly.

Level III:

• Minimum of four (4) years health insurance or related operations work experience and proven ability to exercise the requirements and responsibilities of the position preferred.
• Must have strong written and verbal communication skills.
• Strong Computer proficiency, including experience in Microsoft Office Suite (Excel)
• Rating of "Performing